PCN workload 'unmanageable' even before controversial draft plans, BMA poll reveals

Half of primary care network (PCN) clinical directors said their workload was unmanageable even before 'impossible' draft service specifications were published in December - and one in 10 planned to quit within a year, a BMA poll reveals.

Responding to a BMA survey conducted in October and November 2019 on their experience of setting up and running networks, 11% of clinical directors said they did not intend to be in the role next year, while 27% said they were unsure if they would stay.

Almost half (49%) of the 213 respondents said their workload was ‘unmanageable’ - while just a quarter said they were coping with the workload.

More than a third of PCN clinical directors said the support they had received from their area's integrated care system (ICS) or sustainability and transformation partnership (STP) was ‘poor’ - a finding the BMA called ‘concerning’.

Draft PCN plans

The results of the BMA’s first clinical director survey follow widespread criticism from GPs - including senior doctors leading PCNs - of draft network DES service specifications published by NHS England and Improvement before Christmas.

Clinical directors across Dorset have unanimously rejected the draft plans, while more than 1,000 GPs have signed a petition calling for the 'impossible' plans to be scrapped and LMCs have advised practices not to sign up to the DES in its current form.

Chair of Suffolk Primary Care superpartnership Dr Nick Rayner announced last week that he was standing down from his clinical director role due to workload pressures the draft specifications would create.

The BMA - which is set to negotiate with NHS leaders in the coming weeks to shape the final DES specifications - said signs of 'early optimism' around PCNs from some GPs who took part in its survey were likely to have been ‘seriously impacted’ by the draft plans.

GP workload

BMA GP committee chair Dr Richard Vautrey said the findings showed 'the drive and ambition of clinical directors, who want PCNs to both improve services for patients and begin to address some of the pressures that have been negatively impacting general practice for the last decade'.

But he added: 'It’s clear that PCNs cannot be expected to solve all problems facing the profession and the wider NHS – especially if concerns around present levels of workload are not heeded.

‘This is especially relevant with regard to feedback around the recently-published draft service specifications from NHS England and NHS Improvement, with clinical directors right across the country expressing their grave concern about the impossibility of delivering what has been specified, even with the planned workforce expansion.

‘Less than a year after they were introduced as part of the GP contract, it is a crucial time in the development of PCNs and it is vital they are given adequate funding and practical support – and that any goals are fair and realistic – if they are to deliver on their potential.’

PCNs 'unsustainable'

The BMA survey of over 200 PCN clinical directors found that the level of expectation placed on them and the time and funding allocated to perform their role was ‘simply not sustainable’.

Many said this was frustrating because they had felt confident and enthusiastic about their new role. One clinical director said: ‘My concern going forward is the sheer volume of time and work involved in being a clinical director and the lack of specific management funding for the PCN to facilitate the work.’

‘The amount of work required is nowhere near met by the clinical director reimbursement. Our CCG is permanently in deficit and is therefore actively trying to renege on funding commitments. We have great ideas but cannot work at the pace we want,' said another.

More than a third of clinical directors said they weren’t being well supported by either their ICS or STP, saying help was insufficient or not tailored to their needs. Almost one in five said they weren’t aware such help was available.

A total of 57% of clinical directors reported their relationships with their LMC as ‘strong’ and 55% reported strong links to their CCG.

Despite concerns about workload and support, 63% of clinical directors said they were confident in providing strategic and clinical leadership in their network.

GPs at the 2019 England LMCs conference last November warned that those in charge of networks needed support to push back on unfair demands, including pressure to performance manage local practices.

Meanwhile, Locum GP and clinical director of Bridlington PCN in Yorkshire Dr Zoe Norris argued clinical directors need support to manage their workload to avoid a wave of GPs walking away from the role.

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